NPIMap

Organization Active NPI

Pediatric and Family Medical Center

Doing business as Eisner Pediatric and Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1316044522
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEDIATRIC AND FAMILY MEDICAL CENTER
Doing business as
Eisner Pediatric and Family Medical Center
Practice address
1530 S Olive St
Los Angeles, CA 90015-3023
Phone
(213) 746-1037
Fax
(213) 746-9379
NPI assigned
Sep 20, 2006
Last updated
Apr 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Monica McCarthy
Title
Sr VP, Coo & Interim-Ceo
Phone
(213) 746-1037

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1530 S Olive St
Los Angeles, CA 90015-3023

Mailing address

1530 S Olive St
Los Angeles, CA 90015-3023
Phone (213) 746-1037

Other names 1

  • Eisner Pediatric and Family Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130408000133 CA Part A Provider - Federally Qualified Health Center (FQHC) 1557301678 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316044522. Details of each certification follow.

Federally qualified health center certification: CCN 751012

Legal name
PEDIATRIC AND FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 8, 2013
Last certification
Apr 8, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1920 in CA
Enrollment address
1530 S Olive St
Los Angeles, CA 90015

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

3680 E Imperial Hwy
Ste 215
Lynwood, CA 90262

8640 Van Nuys Blvd
Panorama City, CA 91402
Phone (818) 894-8080

8700 Van Nuys Blvd
Panorama City, CA 91402

15477 Ventura Blvd
Sherman Oaks, CA 91403
Phone (818) 835-3393

15477 Ventura Blvd
Ste 300
Sherman Oaks, CA 91403
Phone (818) 907-0322

1587 Boettler Rd
Ste 104
Green, OH 44685

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sergey Navolnev Individual Corporate OfficerChief Financial Officer Jan 1, 2024
W-2 Managing EmployeeChief Financial Officer Jan 1, 2024
Irma Avila Individual Corporate Director Jan 1, 2012
Monica Gutierrez-McCarthy Individual Corporate OfficerPresident & Ceo Mar 29, 2021
W-2 Managing EmployeePresident & Ceo Mar 29, 2021
Tyler Vogler Individual Corporate OfficerChief Operations Officer Feb 3, 2025
W-2 Managing EmployeeChief Operations Officer Feb 3, 2025
Martine Singer Individual Corporate DirectorBoard Member Nov 1, 2018
Edward Matthews Individual Corporate Director Jan 1, 2005
Stan Berkman Individual Corporate DirectorChair Nov 1, 2018
Christopher Isola Individual Corporate DirectorBoard of Directors Member Jun 8, 2023
Alejandra Rosas Rodriguez Individual Corporate Director Jan 1, 2006
Rupert Grant Individual Corporate DirectorBoard Member Nov 1, 2018
Kevin J Rossi Individual Corporate Director Jan 1, 2001
Ian Weiner Individual Corporate DirectorTreasurer Nov 1, 2018
Victor Aguirre Individual Corporate Director Jan 1, 2009

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1316044522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 S OLIVE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153023",
            "telephone_number": "213-746-1037",
            "fax_number": "213-746-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 S OLIVE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153023",
            "telephone_number": "213-746-1037",
            "fax_number": "213-746-9379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "SR VP, COO & INTERIM-CEO",
        "authorized_official_telephone_number": "213-746-1037"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eisner Pediatric and Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eisner Pediatric and Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.